Advanced

Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage : A register-based study

Willers, Carl; Lekander, Ingrid; Ekstrand, Elisabeth LU ; Lilja, Mikael; Pessah-Rasmussen, Hélène LU ; Sunnerhagen, Katharina S. and Von Euler, Mia (2018) In Biology of Sex Differences 9(1).
Abstract

Background: Differences in stroke care and health outcomes between men and women are debated. The objective of this study was to explore the relationship between patients' sex and post-stroke health outcomes and received care in a Swedish setting. Methods: Patients with a registered diagnosis of acute intracerebral hemorrhage (ICH) or ischemic stroke (IS) within regional administrative systems (ICD-10 codes I61∗or I63∗) and the Swedish Stroke Register during 2010-2011 were included and followed for 1 year. Data linkage to multiple other data sources on individual level was performed. Adjustments were performed for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity in multivariate regression analyses of... (More)

Background: Differences in stroke care and health outcomes between men and women are debated. The objective of this study was to explore the relationship between patients' sex and post-stroke health outcomes and received care in a Swedish setting. Methods: Patients with a registered diagnosis of acute intracerebral hemorrhage (ICH) or ischemic stroke (IS) within regional administrative systems (ICD-10 codes I61∗or I63∗) and the Swedish Stroke Register during 2010-2011 were included and followed for 1 year. Data linkage to multiple other data sources on individual level was performed. Adjustments were performed for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity in multivariate regression analyses of health outcomes and received care. Health outcomes (e.g., survival, functioning, satisfaction) and received care measures (regional and municipal resources and processes) were studied. Results: Study population: 13,775 women and 13,916 men. After case-mix adjustments for the above factors, we found women to have higher 1-year survival rates after both IS (ORfemale = 1.17, p < 0.001) and ICH (ORfemale = 1.65, p < 0.001). Initial inpatient stay at hospital was, however, shorter for women (β female, IS = - 0.05, p < 0.001; β female, ICH = - 0.08, p < 0.005). For IS, good function (mRS ≤ 2) was more common in men (ORfemale = 0.86, p < 0.001) who also received more inpatient care during the first year (β female = - 0.05, p < 0.001). Conclusions: A lower proportion of women had good functioning, a difference that remained in IS after adjustments for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity. The amount of received hospital care was lower for women after adjustments. Whether shorter hospital stay results in lower function or is a consequence of lower function cannot be elucidated. One-year survival was higher in men when no adjustments were made but lower after adjustments. This likely reflects that women were older at time of stroke, had more severe strokes, and more disability pre-stroke - factors that make a direct comparison between the sexes intricate.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Epidemiology, Health outcomes, Resources, Sex, Stroke, Utilization
in
Biology of Sex Differences
volume
9
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85043239706
ISSN
2042-6410
DOI
10.1186/s13293-018-0170-1
language
English
LU publication?
yes
id
b8c25a18-658f-4a58-b65e-2228ddf30287
date added to LUP
2018-03-20 08:58:24
date last changed
2018-11-11 05:01:06
@article{b8c25a18-658f-4a58-b65e-2228ddf30287,
  abstract     = {<p>Background: Differences in stroke care and health outcomes between men and women are debated. The objective of this study was to explore the relationship between patients' sex and post-stroke health outcomes and received care in a Swedish setting. Methods: Patients with a registered diagnosis of acute intracerebral hemorrhage (ICH) or ischemic stroke (IS) within regional administrative systems (ICD-10 codes I61∗or I63∗) and the Swedish Stroke Register during 2010-2011 were included and followed for 1 year. Data linkage to multiple other data sources on individual level was performed. Adjustments were performed for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity in multivariate regression analyses of health outcomes and received care. Health outcomes (e.g., survival, functioning, satisfaction) and received care measures (regional and municipal resources and processes) were studied. Results: Study population: 13,775 women and 13,916 men. After case-mix adjustments for the above factors, we found women to have higher 1-year survival rates after both IS (OR<sub>female</sub> = 1.17, p &lt; 0.001) and ICH (OR<sub>female</sub> = 1.65, p &lt; 0.001). Initial inpatient stay at hospital was, however, shorter for women (β <sub>female, IS</sub> = - 0.05, p &lt; 0.001; β <sub>female, ICH</sub> = - 0.08, p &lt; 0.005). For IS, good function (mRS ≤ 2) was more common in men (OR<sub>female</sub> = 0.86, p &lt; 0.001) who also received more inpatient care during the first year (β <sub>female</sub> = - 0.05, p &lt; 0.001). Conclusions: A lower proportion of women had good functioning, a difference that remained in IS after adjustments for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity. The amount of received hospital care was lower for women after adjustments. Whether shorter hospital stay results in lower function or is a consequence of lower function cannot be elucidated. One-year survival was higher in men when no adjustments were made but lower after adjustments. This likely reflects that women were older at time of stroke, had more severe strokes, and more disability pre-stroke - factors that make a direct comparison between the sexes intricate.</p>},
  articleno    = {11},
  author       = {Willers, Carl and Lekander, Ingrid and Ekstrand, Elisabeth and Lilja, Mikael and Pessah-Rasmussen, Hélène and Sunnerhagen, Katharina S. and Von Euler, Mia},
  issn         = {2042-6410},
  keyword      = {Epidemiology,Health outcomes,Resources,Sex,Stroke,Utilization},
  language     = {eng},
  month        = {03},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {Biology of Sex Differences},
  title        = {Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage : A register-based study},
  url          = {http://dx.doi.org/10.1186/s13293-018-0170-1},
  volume       = {9},
  year         = {2018},
}